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Al Qasem M, Meyyazhagan A, Tsibizova V, Clerici G, Arduini M, Khader M, M Alkarabsheh A, Di Renzo GC. Knots of the umbilical cord: Incidence, diagnosis, and management. Int J Gynaecol Obstet 2024. [PMID: 38264935 DOI: 10.1002/ijgo.15373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
Knot(s) of the umbilical cord have received emphasis because the clinical assessments and sonographic literature show a crucial role in fetal outcomes. The true umbilical cord knot could be a knot in a singleton pregnancy or an entanglement of two umbilical cords in monoamniotic twins. Clinical manifestations are almost silent, which can raise clinical challenges. They worsen outcomes, and the pathology can be easily missed during prenatal visits because ultrasonographers do not pay attention to the cord during an obstetric ultrasound scan. However, most medical centers now have ultrasound machines that improve fetal assessment. The umbilical cord should be routinely evaluated during a fetal assessment, and suspicion of an umbilical cord knot can be more frequently diagnosed and is detected only incidentally. Clinical outcome is usually good but depends on the knot's characteristics and if it is tight or loose. In this review, we discuss pathophysiology, the theories on formation, the main risk factors, ultrasound signs and findings, different opinions in the management, and features of pregnancy outcomes feature.
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Affiliation(s)
- Malek Al Qasem
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Arun Meyyazhagan
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
- PREIS International School, Firenze, Italy
| | - Valentina Tsibizova
- PREIS International School, Firenze, Italy
- CEMER, European Centre for Medical Research, Perugia, Italy
| | - Graziano Clerici
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- CEMER, European Centre for Medical Research, Perugia, Italy
| | - Maurizio Arduini
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Mohammed Khader
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Ahlam M Alkarabsheh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- PREIS International School, Firenze, Italy
- Department of Obstetrics, Gynecology and Perinatology, IE Sechenov First State University, Moscow, Russian Federation
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2
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Starek Z, Di Cori A, Betts T, Clerici G, Gras D, Lyan E, Della Bella P, Li J, Hack B, Zitella Verbick L, Sommer P. Low voltage area as a predictor of recurrence after a single pulmonary vein isolation procedure: results of the WAVE-MAP AF study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Pulmonary vein isolation (PVI) is a recommended approach for atrial fibrillation (AF) ablation procedures. Substrate modification beyond PVI has mixed results but identifying and ablating low voltage zones and ablating those targets in addition to PVI may be beneficial. Electroanatomic mapping is critical to identify subjects that may require further substrate modification. Low voltage area may be predictive of optimal treatment approach.
Purpose
This was a prospective, multicenter, interventional study of a high-density grid-style mapping catheter (HD Grid) to characterize left atrial low voltage substrate during sinus rhythm (SR) and AF and identify associations with 12 month recurrence rates after a single de novo radiofrequency (RF) ablation using a PVI only approach.
Methods
This study (NCT03882021) enrolled 300 subjects at 18 centers in Europe and Israel. Subjects underwent de novo RF ablation for paroxysmal AF (PAF) (N=113), early persistent AF (PsAF; AF sustained 7 days to 3 months) (N=86) or non-early PsAF (AF sustained >3 months to 12 months) (N=101). High density voltage maps were collected with HD Grid. Two pre-ablation maps, in SR and AF, were created for each subject (N=196) followed by PVI only ablation. Low voltage area (using cutoffs of 0.1 mV to 1.5 mV) was investigated in SR and AF. Follow up visits were at 3, 6 and 12 months post-ablation, with a 24-hour Holter monitor at 12 months. A Cox proportional hazards model was used to identify associations between mapping data and 12 month AF/atrial flutter (AFL)/atrial tachycardia (AT) recurrence after a single PVI procedure.
Results
At 12 months, 75.5% of subjects were free from AF/AFL/AT recurrence. On average, PsAF subjects had more low voltage area than PAF subjects in SR and AF. However, while univariate analysis found no correlation between recurrence and PAF or PsAF diagnosis (p=0.1261), those with recurrence had a significantly larger percent left atrial low voltage area under 0.5 mV with simultaneous orthogonal bipole wave configuration (HDW) in both AF (p=0.0011) and SR (p=0.0210) than those without recurrence. Using HDW, low voltage area (identified as <0.5 mV) greater than 28% of the left atrium in SR (HR: 4.82, 95% CI: 2.08–11.18, p=0.0003) and greater than 72% in AF (HR: 5.66, 95% CI: 2.34–13.69, p=0.0001) were associated with a higher risk of AF/AFL/AT recurrence at one year.
Conclusion(s)
Using a standard cutoff of 0.5 mV, a larger percent low voltage area was associated with increased risk of recurrence in both SR and AF. Future analyses will explore optimal low voltage cutoffs and thresholds predictive of recurrence that may necessitate additional substrate modification beyond PVI.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
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Affiliation(s)
- Z Starek
- St. Anne University Hospital Brno (FNUSA) , Brno , Czechia
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - T Betts
- John Radcliffe Hospital , Oxford , United Kingdom
| | - G Clerici
- Centre Hospitalier Universitaire de La Reunion , La Réunion , France
| | - D Gras
- Hôpital Privé du Confluent , Nantes , France
| | - E Lyan
- Cardiovascular Center Bad Bevensen , Bad Bevensen , Germany
| | | | - J Li
- Abbott , Saint Paul , United States of America
| | - B Hack
- Abbott , Saint Paul , United States of America
| | | | - P Sommer
- Heart and Diabetes Center NRW , Bad Oeynhausen , Germany
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3
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Starek Z, Di Cori A, Betts T, Clerici G, Gras D, Lyan E, Li J, Hack B, Zitella Verbick L, Sommer P. High density wave mapping to characterize low voltage substrate in sinus rhythm and atrial fibrillation: acute results from the WAVE-MAP AF study. Europace 2022. [DOI: 10.1093/europace/euac053.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
Pulmonary vein isolation (PVI) is a recommended approach for all atrial fibrillation (AF) ablation procedures, but PVI alone does not cure all AF. Supplementary substrate modification beyond PVI has mixed results. Identifying low voltage zones and ablating those targets in addition to PVI may be beneficial. Electroanatomic mapping is critical to identify subjects that may require further substrate modification. The amount of low voltage area may be predictive of the optimal treatment approach.
Purpose
This was a prospective, multicenter, interventional study of a high-density grid-style mapping catheter (HD Grid) to characterize left atrial (LA) low voltage substrate during sinus rhythm (SR) and AF in subjects undergoing de novo radiofrequency (RF) ablation for paroxysmal AF (PAF), early persistent AF (PsAF) (7 days-3 months) or non-early PsAF (>3 months-12 months) using a PVI only approach.
Methods
High-density voltage maps were collected with HD Grid during both SR and AF prior to ablation. Differences in low voltage area between (1) SR and AF and (2) simultaneous orthogonal bipole wave configuration (HDW) and standard along-the-spline linear electrode configuration (SD) were investigated.
Results
Three hundred subjects, enrolled at 18 centers in Europe and Israel, underwent PVI only RF ablation for PAF (N=113), early PsAF (N=79), and non-early PsAF (N=108). The average age was 62.0 ± 9.5 years and 70.3% (211/300) were male. SR maps and AF maps were available and evaluated in HDW and SD for 196 subjects (65.3%) (63 PAF, 65 early PsAF, 68 non-early PsAF). Mean LA surface area was 108.8 cm² and mean mapped surface area ranged from 83.2 to 89.5 cm².
HDW maps showed less low voltage area compared to SD in all subgroups, both in AF and in SR (Figure). For example, in AF with a low voltage cutoff of 0.5 mV, mean low voltage area was 49.8 cm² using SD and only 45.6 cm² using HDW (p<.0001). Similarly, in SR with a low voltage cutoff of 0.5 mV, mean low voltage area was 16.1 cm² using SD and only 12.6 cm² using HDW (p<.0001). HDW showed significantly less low voltage area than SD in SR for all measured voltage cutoffs from 0.1 mV to 1.5 mV.
On average, non-early PsAF subjects had a larger low voltage area than early PsAF subjects and PAF subjects in both SR and AF. In SR HDW, non-early PsAF subjects had 15.6 cm² under 0.5 mV, early PsAF subjects had 12.4 cm², and PAF subjects had 9.2 cm² (p=.0316). In AF HDW, non-early PsAF subjects had 56.6 cm² under 0.5 mV, early PsAF had 42.8 cm² and PAF subjects had 35.4 cm² (p<.0001).
Conclusion
Non-early PsAF subjects had the largest low voltage area on average compared to both early PsAF and PAF subjects in this study. Using HD grid, HDW provided better low voltage area characterization compared to SD in both SR and AF. The final results of this study will suggest whether an HDW substrate characterization of low voltage area can predict recurrences after a single PVI-only strategy procedure.
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Affiliation(s)
- Z Starek
- St. Anne University Hospital Brno (FNUSA), Brno, Czechia
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - T Betts
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - G Clerici
- Centre Hospitalier Universitaire de La Reunion, La Réunion, France
| | - D Gras
- Hôpital Privé du Confluent, Nantes, France
| | - E Lyan
- Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany
| | - J Li
- Abbott, Saint Paul, United States of America
| | - B Hack
- Abbott, Saint Paul, United States of America
| | | | - P Sommer
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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Clerici G, Kaptilny VA, Ishenko AI, Tsibizova V, Aisa MC, Cutuli AM. Fetal pulmonary hemodynamics: Doppler reference values in low risk pregnancies. J Matern Fetal Neonatal Med 2021; 35:8912-8918. [PMID: 34823418 DOI: 10.1080/14767058.2021.2006629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate fetal pulmonary hemodynamics in normal pregnancy using pulsed and color Doppler ultrasonography and to define Doppler reference ranges values in the whole fetal pulmonary circulation during different gestational ages. MATERIALS AND METHODS A prospective observational study was conducted to evaluate 190 healthy singleton pregnancies between 20 and 38 weeks of gestation, including 10 cases for each gestational age. The main pulmonary artery, right pulmonary artery, left pulmonary artery, ductus arteriosus and pulmonary veins waveforms were evaluated. The waveform profile was studied for each pulmonary vessel investigated. We calculated the normal distribution of data of 12 Doppler parameters, their values were expressed as 5th, 25th, 50th, 75th and 95th centile. RESULTS We report several pulmonary hemodynamic changes with the progression of pregnancy. We focused on the hemodynamic values of the parameters most useful in clinical practice and that would better describe the hemodynamic events of this vascular district. CONCLUSION This study reports a complete description of the fetal pulmonary hemodynamics at different gestational ages. Many hemodynamic parameters show a typical change during gestation. The reference ranges described in this study may help in situations where is indicated to evaluate the pulmonary hemodynamics and to identify healthy fetuses from those affected by pathological conditions related mainly to fetal cardiovascular anomalies and/or feto-maternal pathologic conditions.
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Affiliation(s)
- Graziano Clerici
- Department of Obstetrics and Gynecology, 1st Institute of Clinical Medicine, I.M. Sechenov, First Moscow State Medical University, Moscow, Russia.,European Medical and Research Center (CEMER), Perugia, Italy.,Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Vitaly Alexandrovich Kaptilny
- Department of Obstetrics and Gynecology, 1st Institute of Clinical Medicine, I.M. Sechenov, First Moscow State Medical University, Moscow, Russia
| | - Anatoly Ivanovich Ishenko
- Department of Obstetrics and Gynecology, 1st Institute of Clinical Medicine, I.M. Sechenov, First Moscow State Medical University, Moscow, Russia
| | - Valentina Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, Saint Petersburg, Russia
| | - Maria Cristina Aisa
- European Medical and Research Center (CEMER), Perugia, Italy.,Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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Aisa MC, Barbati A, Cappuccini B, Clerici G, Gerli S, Borisova A, De Rosa F, Kaptilnyy VA, Ishenko AI, Renzo GCD. 3-D Echo Brain Volumes to Predict Neurodevelopmental Outcome in Infants: A Prospective Observational Follow-up Study. Ultrasound Med Biol 2021; 47:2220-2232. [PMID: 33994230 DOI: 10.1016/j.ultrasmedbio.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/10/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
Prematurity and intra-uterine growth restriction (IUGR) are risk factors for long-term poor neurodevelopmental outcomes and are associated with reductions in regional brain volumes. In this study, the aim was to determine the possible role of 3-D ultrasonography (3-DUS) volumes of whole brain, thalamus, frontal cortex and cerebellum, measured at postnatal days 30-40, as early predictors of long-term risk for neurobehavioral disorders. To this purpose, a heterogeneous population of full-term, preterm, IUGR and preterm IUGR (pre-IUGR) born individuals (n = 334), characterized by gestational age and birth weight in the ranges 24-41 wk and 860-4000 g, respectively, was followed from postnatal days 30-40 to the second year of life. At enrollment, brain volumes were measured using 3-DUS, whereas neurodevelopment was assessed at 2 y using the Griffiths III test. Cerebral volumes were strictly and significantly lower in infants characterized by a negative outcome and had excellent diagnostic accuracy. The 3-DUS volume of whole brain, thalamus, frontal cortex or cerebellum may be an early predictor of neonates at major risk for neurobehavioral disorders in later life.
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Affiliation(s)
- Maria Cristina Aisa
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy.
| | - Antonella Barbati
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Graziano Clerici
- Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy; Department of Obstetrics and Gynecology, No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Anna Borisova
- Department of Obstetrics and Gynecology with the Course of Perinatology, People's Friendship University of Russia (RUDN University), Moscow, Russia
| | | | - Vitaly Alexandrovich Kaptilnyy
- Department of Obstetrics and Gynecology, No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anatoly Ivanovich Ishenko
- Department of Obstetrics and Gynecology, No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Gian Carlo Di Renzo
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy; Second Department of Obstetrics and Gynecology, I. M. Sechenov First State Medical University, Moscow, Russia
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Aisa MC, Barbati A, Cappuccini B, De Rosa F, Gerli S, Clerici G, Kaptilnyy VA, Ishenko AI, Di Renzo GC. Urinary Nerve Growth Factor in full-term, preterm and intra uterine growth restriction neonates: Association with brain growth at 30-40 days of postnatal period and with neuro-development outcome at two years. A pilot study. Neurosci Lett 2020; 741:135459. [PMID: 33223047 DOI: 10.1016/j.neulet.2020.135459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF) are crucial for the peripheral and central nervous system development, respectively, and differential brain and blood levels in Intra Uterine Growth Restriction (IUGR) and prematurity have been found. As reduced growth of brain regions, measured at 30-40 days of postnatal period, has been demonstrated in preterm and IUGR neonates who showed impaired neuro-development at two years of age, in this study, the levels of NGF and BDNF were evaluated in the urine samples of 30-40 day-old subjects who were full-term, preterm and IUGR and showed a normal or an abnormal neuro-development at follow up after two years. Neurotrophins were measured concurrently with volumes of whole brain, thalamus, frontal cortex and cerebellum. Values were then correlated with later neuro-developmental outcome. Biochemical parameters and cerebral volumes were assessed using colorimetric ELISA kits and three-dimensional ultra-sonography (3DUS), respectively. Neuro-development was estimated using the Griffiths-II test. Urinary NGF and brain volumes significantly correlated and were lower in preterm and IUGR subjects characterized by poor neuro-development. No differences were seen in the case of BDNF. The present investigation demonstrates, for the first time, the strong and direct association of NGF with brain growth at the initial phase of the postnatal period and with neuro-developmental outcome in later life. Remarkably, urinary NGF may be suggested as an early prognostic indicator of high long-term risk of motor and cognitive impairment in IUGR and preterm neonates.
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Affiliation(s)
- Maria Cristina Aisa
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy.
| | - Antonella Barbati
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | | | | | - Sandro Gerli
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Department of Obstetrics and Gynecology No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Graziano Clerici
- Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy; Department of Obstetrics and Gynecology No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Vitaly Alexandrovich Kaptilnyy
- Department of Obstetrics and Gynecology No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Anatoly Ivanovich Ishenko
- Department of Obstetrics and Gynecology No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Gian Carlo Di Renzo
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Second Department of Obstetrics and Gynecology, I. M. Sechenov First State Medical University, 119992 Moscow, Russia; Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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7
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Aisa MC, Barbati A, Gerli S, Clerici G, Nikolova N, Giardina I, Babucci G, De Rosa F, Cappuccini B. Brain 3D-echographic early predictors of neuro-behavioral disorders in infants: a prospective observational study. J Matern Fetal Neonatal Med 2020; 35:642-650. [PMID: 32138566 DOI: 10.1080/14767058.2020.1730323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: Prematurity, low birth weight (LBW), very low birth weight (VLBW), and intrauterine growth restriction (IUGR) are risk factors of long-term poor neuro-development outcomes and associate with reduction of regional brain volumes.Objective: To evaluate the possible role of 3D ultrasound sonography (3DUS) regional brain volumes, measured at 30-40 days of postnatal period, as early predictors of long-term risk of neuro-behavioral disorders.Methods: A highly selected population, which included: full-term, preterm, IUGR, and preterm-IUGR born individuals, was followed longitudinally from 30 to 40 days of postnatal period to the second year of life. The population was mostly composed of bichorionic twins to ensure a, theoretically, major intracategory homogeneity. Preterm and IUGR subjects were characterized by a gestational age (GA) and birth weight (BW)>32 weeks and >1500 g, respectively, whereas the full-term neonates were of 37 weeks GA. At enrollment, the assessment of the volumetric measurements was performed using the 3DUS. The evaluation of neuro-development was performed at 2 years using the Griffiths Mental Development Scales.Results: The 3DUS measurements of whole brain, thalamus, frontal cortex, and cerebellum volumes, assessed at 30-40 days of postnatal period, were significantly reduced in infants characterized by negative outcome. In addition, the respective areas of the ROC curves, made by comparing values of normal and abnormal neuro-development groups, were indicative of a strong diagnostic accuracy.Conclusion: Data found suggest that the 3DUS regional brain volumes may assume a significant role as early indicators of neonates at major risk of neuro-behavioral disorders in later life. Further and larger studies in this direction are needed to validate this significant perspective.
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Affiliation(s)
- Maria Cristina Aisa
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.,GeBiSa, Research Foundation, Perugia, Italy.,Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy
| | - Antonella Barbati
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Sandro Gerli
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.,GeBiSa, Research Foundation, Perugia, Italy.,Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Graziano Clerici
- Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy.,Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Second Department of Obstetrics and Gynecology, First Moscow State Sechenov Medical University, Moscow, Russia
| | - Natasha Nikolova
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.,Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Irene Giardina
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.,Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Giulia Babucci
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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Waldmann V, Bouzeman A, Duthoit G, Marquié C, Labombarda F, Koutbi R, Sellal J, Fauchier L, Mondoly P, Pasquié J, Le Gloan L, Sharifzadehgan A, Clerici G, Nguyen C, Anselme F, Eschalier R, Iserin L, Thambo J, Combes N, Marijon E. Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Background: The development of the fetal central nervous system is one of the most important fields of research in perinatology. Since the early 1980s, 3 D ultrasound has become one of the major research tools in obstetrics and gynecology.Objective: The aim of this study was to reconstruct thalamus, cerebellum and Cortex volumes of fetal brain and generate, for these volumes, growth curves related to gestational age.Methods: We enrolled 344 pregnant women. Using "Tomographic Ultrasound Imaging" (TUI), in all cases we obtained a satisfying 3 D acquisition of fetal brain. We reconstructed offline thalamus, cerebellum and cortex volumes using "Virtual Organ Computer-Aided AnaLysis" (VOCAL) or 4 D View (GE Healthcare).Results: Among the 344 fetuses examined, we obtained 314 thalamus volumes, 252 cerebellum volumes and 261 cortex volumes and we constructed the reference growth curves.Conclusion: Our study confirms the reliability of cerebral volumes evaluation using 3 D technology and how these cerebral structures grow through gestation.
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Affiliation(s)
- Giulia Babucci
- Obstetrics and Gynaecology, University of Perugia, Perugia, Italy
| | - Karl Rosen
- Faculty of Caring Science, Sahlgrenska Academy, University of Gothenburg, Borås, Sweden
| | | | - Graziano Clerici
- 2Nd Department of Obstetrics and Gynecology, I M Sechenov First Moscow State Medical University, Moscow, Russia
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10
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Probst V, Arnaud M, Behar N, Mabo P, Guyomarch B, Tixier R, Briand J, Berthome P, Mansourati J, Babuty D, Maury P, Clerici G, Thollet A, Sacher F, Gourraud JB. P6585Number of ECG leads and prognosis of spontaneous type 1 Brugada syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of sudden cardiac death (SCD). The recent single lead-based diagnosis of Brugada syndrome recommended criterion may lead to overdiagnosis of Brugada syndrome and overestimation of the risk of SCD.
Objective
We aim to investigate the value of a single lead diagnosis in spontaneous type 1 ECG Brugada patient and to investigate the association between the number of ECG leads with a spontaneous type 1 ST elevation and the arrhythmic risk.
Methods
Consecutive patients affected with BrS were recruited in a multicentric prospective registry in France (15 centers) between 1994 and 2016. A total of 1613 patients affected by the Brugada syndrome were enrolled. For this specific study, only patient with a spontaneous type 1 BrS were enrolled (n=505). Data were prospectively collected with an average follow-up of 6.5±4.7 years. ECGs were reviewed by 2 physicians blinded to clinical status. Type 1 ST elevation was defined by ≥2 mm J-point elevation with coved ST segment and negative T wave.
Results
A total of 505 patients with a spontaneous type 1 BrS (mean age 46±15 years, 398 males, 79%) were enrolled. 117 patients (23%) were symptomatic at baseline (32 (6%) aborted SCD, 85 (17%) syncope). Implantable cardiac defibrillator (ICD) was implanted in 191 patients (38%).
Brugada ECG pattern was found in 1 lead in 250 patients (50%, group 1), in 2 leads in 227 patients (45%, group 2) and in 3 leads in 28 patients (5%, group 3). Groups were comparable in term of clinical presentation except for group 3 who presented more frequently an early repolarization pattern (n=19 (8%) in group 1, n=15 in group 2 (6%) and n=7 (25%) in group 3, p=0.02) and more frequently QRS fragmentation (n=6 (2%) in group 1, n=3 in group 2 (1%) and n=3 (11%) in group 3, p=0.03).
During follow-up, 46 (9%) patients presented an arrhythmic event: 22 (9%) in group 1 (4 SCD, 14 appropriate ICD therapy, 4 ventricular arrhythmias), 22 (10%) in group 2 (6 SCD, 11 appropriate ICD therapy, 5 ventricular arrhythmias) and 2 (7%) in group 3 (1 SCD, 1 appropriate ICD therapy). Patients with type 1 BrS pattern in 2 or 3 ECG leads had not a significantly higher rate of arrhythmic events than patients with type 1 BrS pattern in only 1 ECG lead (HR: 1.1; 95% CI: 0.6–1.9 for group 2 and HR: 0.7; 95% CI: 0.2–3 for group 2; p=0,087).
Conclusion
In the largest cohort of BrS patients ever described, the prognosis of Brugada syndrome with a spontaneous ECG pattern does not appear to be affected by the number of leads required for diagnostic.
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Affiliation(s)
- V Probst
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - M Arnaud
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - N Behar
- University Hospital of Rennes, Rennes, France
| | - P Mabo
- University Hospital of Rennes, Rennes, France
| | - B Guyomarch
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - R Tixier
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J Briand
- University Hospital of Rennes, Rennes, France
| | - P Berthome
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | | | - D Babuty
- University Hospital of Tours, Tours, France
| | - P Maury
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - G Clerici
- Reunion Regional University Hospital, Saint Pierre, Réunion
| | - A Thollet
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - F Sacher
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J B Gourraud
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
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11
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Probst V, Minier M, Mabo P, Clerici G, Babuty D, Mansourati J, Kyndt F, Thollet A, Sacher F, Gourraud JB. P6587The experience of a French specialized inherited arrhythmia center in the management of long QT syndrome patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Congenital long QT syndrome (LQTS) is a hereditary disease characterized by prolonged QTc interval and risk of ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death in young people.
Objective
The aim of this study is to report the experience of the French referral center of inherited arrhythmia of the University Hospital of Nantes.
Methods
Consecutive patients affected with lonq QT syndrome were recruited in a multicentric prospective registry in France (15 centers) between 1997 and 2018. Clinical data and 12-lead ECG were collected. Genetic screening was performed using dHPLC-DNA sequencing, HRM or targeted sequencing for at least KCNQ1, KCNH2 and SCN5A.
Results
In this study, we enrolled a total of 741 patients affected by LQTS according to the Schwartz score (447 (60%) females, 404 (55%) index cases). Mean age at diagnosis was 33±21 years. In this cohort, 343 patients (46%) were symptomatic: 66 patients experienced resuscitated sudden cardiac death (SCD, 9%), 211 (28%) syncope and 66 (9%) ventricular arrhythmias. One hundred and two patients (14%) had history of familial SCD. At baseline, heart rate was 69±19 bpm, PR 149±39 mm, QRS 86±16 mm and QTc 479±62 mm.
Three hundred and eighty-six patients (52%) were treated with beta-blockers and 88 patients (12%) were implanted with an ICD.
Genetic screening was performed in 668 (90%) patients. Genetic screening for the 3 major genes of LQTS was positive for 411 patients (62%): 165 variants (25%) in KCNQ1, 178 variants (27%) in KCNH2, 68 variants (10%) in SCN5A. Moreover, we found variants in minor genes of LQTS for 22 patients (3%).
During a mean follow-up of 6.2±5.2 years, 64 patients (9%) underwent arrhythmic events (7 SCD (1%), 8 appropriate ICD therapy (1%) and 49 ventricular arrhythmias (7%). The rate of arrhythmic event was 1.39%/y. Mean age at the first event was 41.7±21.5 years. Sixteen patients (2%) died of non-arrhythmic causes.
Conclusion
Care in a specialized inherited arrhythmia center is associated with a low incidence of arrhythmic event (1.39%/y) in patients affected with LQTS.
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Affiliation(s)
- V Probst
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - M Minier
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - P Mabo
- University Hospital of Rennes, Rennes, France
| | - G Clerici
- Reunion Regional University Hospital, Saint Pierre, Réunion
| | - D Babuty
- University Hospital of Tours, Tours, France
| | | | - F Kyndt
- University Hospital of Nantes, Nantes, France
| | - A Thollet
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - F Sacher
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J B Gourraud
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
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12
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Probst V, Clerici G, Babuty D, Badenco N, Marquie C, Leenhardt A, Maury P, Blangy H, Deharo JC, Tfelt-Hansen J, Rudic B, Behar N, Mansourati J, Sacher F, Gourraud JB. P2279First clinical evaluation of subcutaneous implantable cardiac defibrillator in Brugada patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of SCD. While Subcutaneous ICD (S-ICD) is a seductive approach to treat these patients, questions raised on the risk of inappropriate shock in this specific population.
Objective
The aim of this study was to evaluate the safety and the effectiveness of the S-ICD in BrS patients.
Methods
We prospectively enrolled 112 BrS patients implanted with S-ICD in 17 European centers. During the screening at least 2 vectors must be suitable but it was not necessary to check for the suitability of the ECG during sodium channel blocker or exercise test. S-ICD indications follow the current guidelines.
Results
Mean age of patients was 45±13 years, with 95 (85%) males. Implantation was performed in 91 (83%) patients for primary prevention and in 18 (16%) patients for secondary prevention. There is an indication of ICD replacement for 16 patients (14%): 13 lead defect (81%), 1 infection (6%) and 2 ICD end of life (13%). In this cohort, 57 patients (51%) had spontaneous type I BrS, 60 patients (55%) were symptomatic: 10 resuscitated SCD (17%) and 48 (83%) syncope.
Implantation was performed under general anesthesia in 79 patients (71%). The mean operation time was 56±19 min. The lead was placed at the left side of the sternum in 102 patients (92%) and at the right side in 9 (8%). Sensing configuration was the primary vector for 46 patients (41%), secondary vector for 57 (51%) and alternative vector for 9 (8%). No complications occurred during implantation.
During a mean follow-up of 15.6 months (0–39 months), 6 patients (5%) had at least one appropriate shock (n=9). The rate of appropriate shock was 4.5%/y. All the VF episodes were successfully treated with the first shock. One patient had VF ablation for recurrent VF. Among the 6 patients who received an appropriate shock, 3 (50%) were implanted for secondary prevention and 3 (50%) were implanted for primary prevention including 2 patients with a history of syncope and one asymptomatic patient.
Twelve patients (11%) had at least one inappropriate shock (n=22) including 2 patients with respectively 8 and 4 inappropriate shocks due to T-wave oversensing. With the SMART pass system the first patient had no more inappropriate shock for now 2 years. The rate of inappropriate shock was 9%/y. One patient died of myocardial infarction.
Five patients (4%) were hospitalized for complications (4 pocket or scar infections and 1 electrode failure).
Conclusion
Our initial experience showed that S-ICD is efficient to treat VF episode in BrS patients. In this population, the rate of inappropriate shock was 9%/y. In view of these results, S-ICD implantation seems to be efficient to protect BrS patients against SCD.
Acknowledgement/Funding
Investigator-Sponsored Research program, Boston Scientific
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Affiliation(s)
- V Probst
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - G Clerici
- Reunion Regional University Hospital, Saint Pierre, Réunion
| | - D Babuty
- University Hospital of Tours, Tours, France
| | - N Badenco
- Hospital Pitie-Salpetriere, Paris, France
| | | | - A Leenhardt
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Maury
- University Hospital of Toulouse, Toulouse, France
| | - H Blangy
- University Hospital of Nancy, Nancy, France
| | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B Rudic
- University Medical Centre of Mannheim, Mannheim, Germany
| | - N Behar
- University Hospital of Rennes, Rennes, France
| | | | - F Sacher
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J B Gourraud
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
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13
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Clerici G, Romanelli M, Tosto V, Tsibizova V, Di Renzo GC. Fetal transient tricuspid valve regurgitation: sonographic features and clinical evolution. J Matern Fetal Neonatal Med 2019; 34:2435-2439. [PMID: 31550963 DOI: 10.1080/14767058.2019.1667326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the prevalence, the sonographic features, the clinical evolution and significance of fetal tricuspid valve regurgitation (TR). STUDY DESIGN This is a prospective study. Serial ultrasound examinations were performed at 20-23, at 26-29 and at 30-34 gestational weeks in 675 consecutive singleton pregnancies with fetal normal growth and normal cardiac anatomy. The fetal tricuspid valve regurgitation was classified according to its duration, to the peak of jet maximum velocity and to its maximum spatial extension. A clinical examination and echocardiography were performed in neonates after birth. RESULTS During the first examination (20-23 weeks), 32 cases of tricuspid valve regurgitation were identified. The prevalence of tricuspid regurgitation was 4.74%. The large majority of TR cases were not-holosystolic (87.5%), with a maximum velocity below 2 m/sec (80-130 cm/sec in 84% cases and 180-200 cm/sec in 16% cases) and with a little spatial extension (type I or II in 87.5% cases). Following this hemodynamic phenomenon during the following weeks, we found that it disappeared around 29 weeks in all cases. CONCLUSIONS Tricuspid regurgitation observed during the second trimester can be considered a transient and functional hemodynamic phenomenon, without apparent pathological significance.
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Affiliation(s)
- Graziano Clerici
- European Medical and Research Center (CEMER), University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Maila Romanelli
- European Medical and Research Center (CEMER), University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Valentina Tosto
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia.,Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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14
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Minier M, Probst V, Mabo P, Clerici G, Babuty D, Mansourati J, Kyndt F, Thollet A, Sacher F, Gourraud J. Prognosis of long QT syndrome patients: The experience of the French referral center of Nantes hospital. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.02.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Probst V, Clerici G, Babuty D, Badenco N, Marquie C, Leenhardt A, Maury P, Blangy H, Deharo JL, Tfelt-Hansen J, Rudic B, Behar N, Mansourati J, Sacher F, Gourraud JB. 3298First clinical evaluation of subcutaneous implantable cardiac defibrillator in brugada patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Probst
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - G Clerici
- Reunion Regional University Hospital, Saint Pierre, Reunion
| | - D Babuty
- University Hospital of Tours, Tours, France
| | - N Badenco
- Hospital Pitie-Salpetriere, Paris, France
| | - C Marquie
- Lille University Hospital, Lille, France
| | - A Leenhardt
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Maury
- University Hospital of Toulouse, Toulouse, France
| | - H Blangy
- University Hospital of Nancy, Nancy, France
| | - J L Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B Rudic
- University Medical Centre of Mannheim, Mannheim, Germany
| | - N Behar
- University Hospital of Rennes, Rennes, France
| | | | - F Sacher
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J B Gourraud
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
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16
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Romani R, Manni G, Donati C, Pirisinu I, Bernacchioni C, Gargaro M, Pirro M, Calvitti M, Bagaglia F, Sahebkar A, Clerici G, Matino D, Pomili G, Di Renzo GC, Talesa VN, Puccetti P, Fallarino F. S1P promotes migration, differentiation and immune regulatory activity in amniotic-fluid-derived stem cells. Eur J Pharmacol 2018; 833:173-182. [PMID: 29886240 PMCID: PMC6086338 DOI: 10.1016/j.ejphar.2018.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022]
Abstract
Stem cells have high potential for cell therapy in regenerative medicine. We previously isolated stem cell types from human amniotic fluid, derived from prenatal amniocentesis. One type, characterized by a fast doubling time, was designated as fast human amniotic stem cells (fHASCs). These cells exhibited high differentiation potential and immunoregulatory properties. Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid metabolite that influences stem-cell pluripotency, differentiation, mobility, and regulates immune functions. In this study, we investigated the influence of S1P on fHASC migration, proliferation, differentiation and immune regulatory functions. We found that fHASC stimulation with S1P potentiated their migratory and proliferative activity in vitro. Notably, short fHASC exposure to S1P enhanced their differentiation towards multiple lineages, including adipocytes, osteocytes and endothelial cells, an effect that was associated with downregulation of the main transcription factors involved in the maintenance of a stem-cell undifferentiated state. A specific crosstalk between S1P and tumor growth factor β1 (TGF-β1) has recently been demonstrated. We found that fHASC exposure to S1P in combination with TGF-β1 promoted the expression of the immune regulatory pathway of indoleamine 2,3-dioxygenase 1 (IDO1). In addition, human peripheral blood mononuclear cells, co-cultured with fHASCs treated with S1P and TGF-β1, expanded regulatory T-cells, via a mechanism requiring IDO1. Overall, this study demonstrates that S1P potentiates several properties in fHASCs, an effect that may be critical for exploiting the therapeutic potential of fHASCs and might explain the specific effects of S1P on stem cells during pregnancy.
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Affiliation(s)
- Rita Romani
- Department of Experimental Medicine, University of Perugia, Italy
| | - Giorgia Manni
- Department of Experimental Medicine, University of Perugia, Italy
| | - Chiara Donati
- Department of Experimental Biomedical Sciences and Clinics University of Florence, Italy
| | - Irene Pirisinu
- Department of Experimental Medicine, University of Perugia, Italy
| | - Caterina Bernacchioni
- Department of Experimental Biomedical Sciences and Clinics University of Florence, Italy
| | - Marco Gargaro
- Department of Experimental Medicine, University of Perugia, Italy
| | - Matteo Pirro
- Department of Medicine, University of Perugia, Italy
| | - Mario Calvitti
- Department of Experimental Medicine, University of Perugia, Italy
| | | | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Graziano Clerici
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Davide Matino
- Department of Experimental Medicine, University of Perugia, Italy
| | - Giovanni Pomili
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Paolo Puccetti
- Department of Experimental Medicine, University of Perugia, Italy
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17
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Affiliation(s)
- Graziano Clerici
- Centre of Reproductive and Perinatal Medicine, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Eleonora Giulietti
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Giulia Babucci
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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18
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Di Renzo GC, Giardina I, Clerici G, Brillo E, Gerli S. Progesterone in normal and pathological pregnancy. Horm Mol Biol Clin Investig 2017; 27:35-48. [PMID: 27662646 DOI: 10.1515/hmbci-2016-0038] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Abstract
Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. It has been proposed and extensively used in the treatment of different gynecological pathologies as well as in assisted reproductive technologies and in the maintenance of pregnancy. Called "the pregnancy hormone", natural progesterone is essential before pregnancy and has a crucial role in its maintenance based on different mechanisms such as: modulation of maternal immune response and suppression of inflammatory response (the presence of progesterone and its interaction with progesterone receptors at the decidua level appears to play a major role in the maternal defense strategy), reduction of uterine contractility (adequate progesterone concentrations in myometrium are able to counteract prostaglandin stimulatory activity as well as oxytocin), improvement of utero-placental circulation and luteal phase support (it has been demonstrated that progesterone may promote the invasion of extravillous trophoblasts to the decidua by inhibiting apoptosis of extravillous trophoblasts). Once the therapeutic need of progesterone is established, the key factor is the decision of the best route to administer the hormone and the optimal dosage determination. Progesterone can be administered by many different routes, but the most utilized are oral, the vaginal and intramuscular administration. The main uses of progesterone are represented by: threatened miscarriage, recurrent miscarriage and preterm birth (in the prevention strategy, as a tocolytic agent and also in the maintenance of uterine quiescence).
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Abstract
Anemia is the most frequent derailment of physiology in the world throughout the life of a woman. It is a serious condition in countries that are industrialized and in countries with poor resources. The main purpose of this manuscript is to give the right concern of anemia in pregnancy. The most common causes of anemia are poor nutrition, iron deficiencies, micronutrients deficiencies including folic acid, vitamin A and vitamin B12, diseases like malaria, hookworm infestation and schistosomiasis, HIV infection and genetically inherited hemoglobinopathies such as thalassemia. Depending on the severity and duration of anemia and the stage of gestation, there could be different adverse effects including low birth weight and preterm delivery. Treatment of mild anemia prevents more severe forms of anemia, strictly associated with increased risk of fetal-maternal mortality and morbidity.
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Affiliation(s)
- Gian Carlo Di Renzo
- Department of Obstetrics & Gynecology, University of Perugia, 1, Perugia 06100, Italy
| | - Filippo Spano
- Department of Obstetrics & Gynecology, University of Perugia, 1, Perugia 06100, Italy
| | - Irene Giardina
- Department of Obstetrics & Gynecology, University of Perugia, 1, Perugia 06100, Italy
| | - Eleonora Brillo
- Department of Obstetrics & Gynecology, University of Perugia, 1, Perugia 06100, Italy
| | - Graziano Clerici
- Department of Obstetrics & Gynecology, University of Perugia, 1, Perugia 06100, Italy
| | - Luis Cabero Roura
- Department of Obstetrics & Gynecology, Hospital Vall D'Hebron, 119-129, Barcelona 08035, Spain
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20
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Airoldi F, Baldino G, Mortola P, Losa S, Clerici G, Tavano D, Latib A, Gori A, Faglia E. Nitinol stents with polymer-free paclitaxel coating for stenosis of failing infrainguinal bypass grafts. J Cardiovasc Surg (Torino) 2013; 54:441-445. [PMID: 24013532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM This study was designed to investigate the immediate and one-year outcomes of polymer-free paclitaxel coated drug-eluting stent (DES) implantation in a consecutive series of patients presenting with stenosis of infrainguinal bypass grafts. METHODS Between January 2011 and January 2012, 11 patients with failing infrainguinal bypass grafts were treated in two institutions. Clinical status and Duplex scan parameters were recorded at baseline and over a follow-up period of one year. RESULTS DES implantation was successfully performed in all patients. Ten patients received a single stent and one patient received two stents. At one year, one patient showed total bypass graft occlusion (9%). In all the remaining patients, Duplex scan examination documented patency of the treated grafts. CONCLUSION DES implantation in failing infrainguinal bypass grafts can be safely performed and provides satisfactory clinical outcomes. The patency rate of 91% favourably compares with those obtained with other endovascular treatments such as plain balloon or cutting balloon angioplasty.
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MESH Headings
- Aged
- Aged, 80 and over
- Alloys
- Angioplasty, Balloon/adverse effects
- Angioplasty, Balloon/instrumentation
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Cardiovascular Agents/administration & dosage
- Constriction, Pathologic
- Drug-Eluting Stents
- Female
- Graft Occlusion, Vascular/diagnosis
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/physiopathology
- Graft Occlusion, Vascular/therapy
- Humans
- Italy
- Lower Extremity/blood supply
- Male
- Middle Aged
- Paclitaxel/administration & dosage
- Prosthesis Design
- Prosthesis Failure
- Time Factors
- Treatment Outcome
- Ultrasonography, Doppler, Duplex
- Vascular Patency
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Affiliation(s)
- F Airoldi
- Cardiovascular Department, Multimedica IRCCS, Sesto San Giovanni, Milan, Italy -
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21
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Porcaro G, Clerici G, Romanelli M, Giulietti E, Antonelli C, Babucci G, Di Renzo GC. [Effectiveness of a new cervicometer in evaluating the risk of preterm delivery]. Minerva Ginecol 2013; 65:327-330. [PMID: 23689176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The ultrasound measurement of the cervix is the gold standard for assessing the risk of preterm delivery. We compared the accuracy of this technique with measurements obtained by the cervicometer Cervilenz®. The purpose was to show that this device can be used as a screening tool, low cost, in the diagnosis of preterm labor. METHODS Fifty patients were included in the study at gestational age between 21+0 and 26 +0 or weeks. The study was blinded between the two performers utilizing the cervicometer and the transvaginal ultrasound. RESULTS The study showed 100% concordance and a correlation between the two techniques of 0.94. CONCLUSION The cervicometer proved to be a reliable and easy to use device to detect a normal or short cervix, with contained healthcare costs.
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Affiliation(s)
- G Porcaro
- Dipartimento di Ostetricia e Ginecologia, Centro di Medicina Perinatale e della RiproduzioneUniversità degli Studi di Perugia, Perugia, Italia
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Clerici G, Antonelli C, Rizzo G, Kanninen TT, Di Renzo GC. Atypical hemodynamic pattern in fetuses with hypercoiled umbilical cord and growth restriction. J Matern Fetal Neonatal Med 2013; 26:558-62. [PMID: 23134215 DOI: 10.3109/14767058.2012.741153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To describe fetal and uterine hemodynamics in intrauterine growth restriction (IUGR) fetuses with hypercoiled umbilical cord. METHODS 102 pregnant women with IUGR fetuses were enrolled in the study. In these cases, hemodynamic indices and Doppler waveform profiles were evaluated. RESULTS In seven of the enrolled cases of IUGR, we found an anomalous umbilical coiling. They showed normal impedance to flow in utero-placental district and abnormal venous umbilical cord pulsatility with flow velocity higher than the umbilical artery. The ductus venosus showed a reduction of the forward flow and/or a reverse flow during atrial contractions. Two of these seven patients had early onset IUGR and a particular deteriorating hemodynamic profile with "brain sparing", severe reverse flow in the ductus venosus, increased reverse flow in the inferior vena cava during atrial contraction and absent flow during the diastole in the umbilical arteries. Five patients had late onset of IUGR and three of these did not demonstrate these worsening hemodynamic alterations until term. CONCLUSIONS In patients with fetal IUGR and hypercoiling without signs of placental insufficiency, we observed an "atypical" feto-maternal hemodynamic pattern. These IUGR fetuses with hypercoiling and fetal venous system hemodynamic alteration can be at high hypoxic risk.
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Affiliation(s)
- Graziano Clerici
- Centre of Reproductive and Perinatal Medicine, Department of Obstetrics/Gynecology, Polo Unico Ospedaliero Santa Maria della Misericordia, University Hospital, San Sisto, Perugia, Italy.
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Ferrari F, Facchinetti F, Porcaro G, Monari F, Clerici G, Carlo Di Renzo G. 484: Cervilenz and ultrasound evaluation of cervimetry: a comparative study. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Progesterone is an essential hormone in the process of reproduction. It has been extensively studied in the treatment of different gynecological pathologies, as a contraceptive and in assisted reproductive technologies. However, the use of progesterone in the pathophysiology of pregnancy remains controversial. Progesterone, and its synthetic form 17 α-hydroxyprogesterone caproate (17 OHP-C), offer an effective intervention when the continuation of pregnancy is at risk from immunological factors, luteinic and neuroendocrine deficiencies, and myometrial hypercontractility. Progesterone has been successfully used as prophylaxis in the prevention of spontaneous miscarriage, with treatment beginning from the first trimester of pregnancy. There is substantial evidence, too, to indicate that women with idiopathic recurrent miscarriage may benefit from the immunomodulatory properties of progesterone in early pregnancy. The use of progesterone and 17 OHP-C has been extensively studied in the prevention of preterm birth in a variety of settings. Transvaginal ultrasound measurement of cervical length in singleton pregnancies between 19 and 24 weeks' gestation has been deemed the best way to identify women (approximately 2% of the pregnant population) who would benefit from prophylactic progesterone treatment for the prevention of spontaneous preterm birth. This paper reviews the evidence for the safety and efficacy of the use of progesterone in each of these indications.
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Affiliation(s)
- Gian Carlo Di Renzo
- Department of Gynecology and Obstetrics, Centre for Reproductive and Perinatal Medicine, University of Perugia, Perugia, Italy.
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Airoldi F, Faglia E, Clerici G, Latib A. Bailout directional atherectomy for side branch salvage following subintimal recanalization of infragenicular arteries. VASA 2012; 41:292-4. [PMID: 22825864 DOI: 10.1024/0301-1526/a000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 64-year old diabetic male presenting with critical limb ischemia was treated with percutaneous angioplasty for occlusion of the infragenicular popliteal artery and crural vessels. Directional atherectomy was uncommonly used in the false lumen created by following subintimal angioplasty of the infrapopliteal vessels for re-access into the true lumen. The positive clinical and angiographic results indicate that atherectomy can be considered a useful tool for rescue interventions to reopen large side branches unintentionally occluded during subintimal angioplasty.
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Affiliation(s)
- F Airoldi
- Cardiovascular Interventional Unit - Multimedica IRCCS - S.S. Giovanni (MI), Italy.
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Clerici G, Babucci G, Renzo GCD. Clinical significance of fetal hyperechogenicities. J OBSTET GYNAECOL 2012; 32:596. [PMID: 22779972 DOI: 10.3109/01443615.2012.690789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Clerici
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, Santa Maria Della Misericordia University Hospital, Perugia, Italy
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Selly JB, Boumahni B, Edmar A, Jamal Bey K, Randrianaivo H, Clerici G, Millat G, Caillet D. [Cardiac sinus node dysfunction due to a new mutation of the SCN5A gene]. Arch Pediatr 2012; 19:837-41. [PMID: 22795782 DOI: 10.1016/j.arcped.2012.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/02/2012] [Accepted: 04/27/2012] [Indexed: 11/29/2022]
Abstract
A 10-year-old child was hospitalized for bradycardia during a viral infection with chikungunya. His history showed unexplored episodes of bradycardia. Cardiologic explorations revealed cardiac sinus node dysfunction (SD). Mutational screening of the SCN5A gene showed that this case was a compound heterozygote for p.Ala735Val and p.Asp1792Asn missense mutants. Five years later, the child underwent a pacemaker insertion after an electrophysiological study performed during an atrial flutter access.
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Affiliation(s)
- J-B Selly
- Service de réanimation néonatale et pédiatrique, CHU groupe hospitalier Sud, avenue du Président François-Mitterand, 97410 Saint-Pierre, Réunion.
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Di Renzo GC, Brillo E, Romanelli M, Porcaro G, Capanna F, Kanninen TT, Gerli S, Clerici G. Potential effects of chocolate on human pregnancy: a randomized controlled trial. J Matern Fetal Neonatal Med 2012; 25:1860-7. [DOI: 10.3109/14767058.2012.683085] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Oxidative stress (OS) plays a role in pregnancy at risk of pre-eclampsia, diabetes and premature labour. We measured three markers of OS: total antioxidant capacity (TAC), thiolyte capacity and pro-oxidant capacity in 45 women: 15 normal pregnancies, 17 pathological pregnancies (pre-eclampsia and pregestational diabetes) and 13 delivered pre-term. Plasma TAC (μmol/ml) values in patients with pathological pregnancies (235.67 ± 70.08) (p(1) = 0.0086) and pre-term labour (243.51 ± 50.52) (p(2) = 0.0479) were significantly reduced as compared with the controls (306.78 ± 70.08). Thiolyte capacity (μmol/ml) in the pathological pregnancies (326.03 ± 78.24) (p(3) = 0.0029) and in pre-term labour (335.94 ± 76.63) (p(4) = 0.0084) groups were significantly reduced compared with the control group (417.48 ± 39.76) (p < 0.05). Pro-oxidant capacity (mg/100 ml) in the pathological pregnancies (94.11 ± 26.13) (p(5) = 0.00034) and in pre-term labour (87.18 ± 20.28) (p(6) = 0.00044) groups were significantly higher compared with the controls (60.27 ± 6.33). Elevated OS values were seen in pathological pregnancies. This supports the important role of OS in diseases in pregnancy, particularly pre-eclampsia, diabetes and pre-term birth.
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Affiliation(s)
- G Clerici
- Centre of Reproductive and Perinatal Medicine, Department of Gynecology and Obstetrics, University of Perugia, Perugia, Italy
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Abstract
AbstractMultiple pregnancy represents a challenge for obstetrics and also poses significant psychological, social and economic problems. The chances of a successful outcome may be improved by appropriate preventive, diagnostic and management strategies, by the availability of specific skills and experience and by a multidisciplinary approach. In this paper are indicated and discussed, on the basis of current evidences, what can be considered the ten “commandments” in terms of providing optimal care in multiple pregnancies. In particular in this review we focus on the following topics: psychological support and clinical counseling; diagnosis and characterization of chorionicity; management at referral centers; individualization of care; avoidance of most frequent complications; consideration of specific pathologies; evaluation of fetal anatomy; monitoring of fetuses; planning of time and mode of delivery; monitoring of the mother during postpartum.
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Di Renzo GC, Giardina I, Rosati A, Clerici G, Torricelli M, Petraglia F. Maternal risk factors for preterm birth: a country-based population analysis. Eur J Obstet Gynecol Reprod Biol 2011; 159:342-6. [DOI: 10.1016/j.ejogrb.2011.09.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/22/2011] [Accepted: 09/14/2011] [Indexed: 12/20/2022]
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Jeannot C, Troucelier E, Mercusot A, Riedel M, Dijoux N, Mimran C, Petit B, Geoffroy O, Clerici G, Giraud M. [Interest of coronary flow reserve of the LAD during dobutamine stress echocardiography]. Ann Cardiol Angeiol (Paris) 2011; 60:197-201. [PMID: 21665185 DOI: 10.1016/j.ancard.2011.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 04/28/2011] [Indexed: 05/30/2023]
Abstract
AIM OF THE STUDY To assess the value of the coronary flow reserve (CFR) in the left anterior descending artery (LAD) during dobutamine stress echocardiography in the diagnosis of significant LAD stenosis (more than 70%). METHOD Retrospective study of 81 patients with a positive stress echocardiography who underwent a coronarography. RESULTS Measurement of coronary flow reserve was able in half echocardiographic exams. Medium Pic diastolic velocity was 0.33 m/s (SD 0.20), medium maximal diastolic velocity during stress was 0.62 m/s (SD 0.20), medium CFR was 2.25 (SD 0.65). In 50 patients LAD was not seen; in five of them LAD was occluded. The predictive positive value (PPV) of a low coronary flow reserve to detect LAD stenosis is 66.7% and the negative predictive value (NPV) is 65.4%. An abnormal anterior contraction during stress echo with a low reserve has a PPV of 75% for the diagnosis of significant IVA stenosis and a normal contraction during stress with normal coronary flow reserve means a NPV of 65%. We did not show a significant correlation between low coronary flow and abnormal contraction during stress echocardiography (kappa 0.51). CONCLUSION Coronary flow reserve of LAD during stress echo is feasible but does not really improve exam performance to detect significant IVA stenosis. This measurement remains to be clear in coronary patients management.
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Affiliation(s)
- C Jeannot
- Service de cardiologie, groupe hospitalier Sud-Réunion, Saint-Pierre cedex.
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Wex J, Abou-Setta AM, Clerici G, Di Renzo GC. Atosiban versus betamimetics in the treatment of preterm labour in Italy: clinical and economic importance of side-effects. Eur J Obstet Gynecol Reprod Biol 2011; 157:128-35. [DOI: 10.1016/j.ejogrb.2011.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 11/29/2022]
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Clerici G, Porcaro G, Kanninen T, Di Renzo GC. The role of serial amnioinfusions in the management of previable pre-term premature rupture of membranes. J OBSTET GYNAECOL 2011; 31:345-7. [PMID: 21534764 DOI: 10.3109/01443615.2011.560298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Clerici
- Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, Santa Maria della Misericordia University Hospital, San Sisto, Perugia, Italy.
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Cruciani L, Gerli S, Baiocchi G, Clerici G, Antonelli C, Di Renzo GC. Ovarian pregnancy afterin vitrofertilisation in a woman with previous bilateral salpingectomy. J OBSTET GYNAECOL 2011; 31:270-1. [DOI: 10.3109/01443615.2011.554613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Arduini M, Rosati P, Caforio L, Guariglia L, Clerici G, Di Renzo GC, Scambia G. Cerebral blood flow autoregulation and congenital heart disease: possible causes of abnormal prenatal neurologic development. J Matern Fetal Neonatal Med 2011; 24:1208-11. [DOI: 10.3109/14767058.2010.547961] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prontera P, Clerici G, Bernardini L, Schippa M, Capalbo A, Manes I, Giuffrida MG, Barbieri MG, Ardisia C, Donti E. Prenatal diagnosis and molecular characterization of an interstitial 1q24.3-31.3 deletion: case report and review. Genet Couns 2011; 22:41-48. [PMID: 21614987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We describe a foetus with an interstitial deletion of 1q detected in amniotic fluid cells and we review the literature of similar pre- and postnatal cases, in order to identify prognostic factors useful for prenatal counselling. Foetal/parents karyotyping and FISH with whole chromosome 1 paint and BAC clone specific for 1q23-32 region were performed. Further 100 Kb resolution array-CGH analysis was executed after pregnancy termination on DNA extracted from foetal skin fibroblasts. Cytogenetic analyses revealed a de novo interstitial deletion involving the long arm of chromosome 1. FISH analysis confirmed that the deletion involves the intermediate 1q31.2 region. Foetal ultrasound (US), performed at 21 weeks of gestation, showed intrauterine growth restriction, shortening of the long bones, echogenic intracardiac focus and mild cerebral ventriculomegaly. Array-CGH localized the deletion in a DNA sequence of about 21 Mb in the 1q24.3-q31.3 region. Our findings, together with available data on patients with 1q deletion, suggest that the most severe phenotypes are not simply associated with larger deletion, and that the results of prenatal US assessment, rather than a fine molecular characterization of the deletion, should be taken into account for prognostic evaluation.
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Affiliation(s)
- P Prontera
- Department of Clinical and Experimental Medicine, Medical Genetics Unit, Polo Unico Ospedaliero Santa Maria della Misericordia University Hospital, Perugia, Italy
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Marchini G, Rosati A, Ribiani E, Romanelli M, Porcaro G, Clerici G. [Nuchal translucency and combined test: what are the implications in clinical practice?]. Minerva Ginecol 2010; 62:187-193. [PMID: 20595943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM The aim of this study was to evaluate the performance of the combined test (nuchal translucency, NT) and maternal serum free-beta human chorionic gonadotropin (free beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), compared to the NT measurement alone, in fetal aneuploidy screening in the general population and in pregnant women aged 35 years and over. In addition, the association between increased NT and presence of cardiac defects in fetuses with normal karyotype was evaluated. METHODS Screening at 11-14 weeks of gestation by NT measurement and combined test was carried out in 1521 pregnant women. The estimated risk for trisomy 21 and trisomy 13+18 was calculated (risk cut-off 1/300 and 1/750 respectively) and the outcomes was evaluated. RESULTS Ten cases of trisomies (21 and 18) occurred, seven of which among the older group of pregnant women. The detection rate (DR) for the combined test was 80% in the general population and 85.7% in older pregnant women, which resulted higher rate than NT measurements alone. Detection rate of cardiac defects using NT measurements was 66.6%. CONCLUSION The combined test is an effective screening for aneuploidies and reduces at 14% the need of invasive testing in the older obstetric population, detecting all the trisomies occurred in this group. The association between increased NT and cardiac defects is confirmed but it seems too weak to consider NT as a single screening strategy for these abnormalities.
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Affiliation(s)
- G Marchini
- Struttura Complessa di Ginecologia e Ostetricia, Università degli Studi di Perugia, Perugia, Italy
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Asciutti S, Kanninen TT, Clerici G, Nardi E, Castellani D, DI Renzo GC, Clerici C. Acute pancreatitis with a mucinous cystoadenoma of the pancreas in pregnancy. Anticancer Res 2010; 30:1025-1028. [PMID: 20393031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pregnancy complicated by pancreatitis is a rare and difficultly managed clinical situation. Gallstones are the most frequent cause of pancreatitis in pregnancy. Non-gallstone pancreatitis in pregnancy has been shown to be significantly more prone to premature delivery and pseudocyst formation. Cystic lesions as a cause of pancreatitis in pregnancy have not, to our knowledge, been observed. Pancreatic cystic lesions in general are rare, but are difficult to treat given problems in clarifying their malignancy. Mucinous cystic neoplasms are considered premalignant lesions and resection is recommended. Receptors for estrogen and progesterone receptors in these cysts may cause cystic growth during pregnancy. Treatment recommendations for pancreatitis in pregnancy are not well defined; this applies as well to treatment protocols for cystic lesions. In this case report we describe a new potential cause of acute pancreatitis in pregnancy due to compression of the principal pancreatic duct by a mucinous cystoadenoma.
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Affiliation(s)
- Stefania Asciutti
- Clinica di Gastroenterologia ed Epatologia, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia 06100, Italy.
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Clerici G, Rosati A, Di Renzo GC. Absent ductus venosus associated with skeletal anomalies of the ulna and radius. Prenat Diagn 2009; 30:83-5. [DOI: 10.1002/pd.2390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Arduini M, Epicoco G, Clerici G, Bottaccioli E, Arena S, Affronti G. B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta. Int J Gynaecol Obstet 2009; 108:191-3. [PMID: 19945698 DOI: 10.1016/j.ijgo.2009.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 10/20/2009] [Accepted: 11/02/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Maurizio Arduini
- S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
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Abstract
In this report, the authors describe the case of a patient with Kaposi's sarcoma that was initially misdiagnosed as a plantar ulcer. The ulcer typically appeared as a neuropathic foot ulceration located on the plantar aspect of the first metatarsal head. There was hyperkeratosis on the plantar surfaces of the other metatarsal heads. However, the lesion had mushrooming granulation tissue, without undermined perilesional edges. A wound biopsy revealed the presence of Kaposi's sarcoma. The presence of cancerous lesions on the plantar aspect of the foot is an infrequent event in diabetic patients. However, given the malignant nature of some skin cancers careful clinical examination and biopsy of the wound are advisable.
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Affiliation(s)
- M Caminiti
- Diabetology Centre, Diabetic Foot Centre, IRCCS MultiMedica, Milan, Italy
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Faglia E, Clerici G, Clerissi J, Caminiti M, Quarantiello A, Curci V, Losa S, Vitiello R, Lupattelli T, Somalvico F. Angioplasty for Diabetic Patients with Failing Bypass Graft or Residual Critical Ischemia after Bypass Graft. J Vasc Surg 2008. [DOI: 10.1016/j.jvs.2008.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boccia RV, Gonzalez EF, Pluzanska AG, Clerici G. Palonosetron (PALO), administered orally or intravenously (IV), plus dexamethasone for prevention of chemotherapy-induced nausea and vomiting (CINV). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Faglia E, Clerici G, Clerissi J, Mantero M, Caminiti M, Quarantiello A, Curci V, Lupattelli T, Morabito A. When is a technically successful peripheral angioplasty effective in preventing above-the-ankle amputation in diabetic patients with critical limb ischaemia? Diabet Med 2007; 24:823-9. [PMID: 17559430 DOI: 10.1111/j.1464-5491.2007.02167.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To determine parameters predictive of avoidance of major (above-the-ankle) amputation after a technically successful peripheral angioplasty (PTA) in patients with diabetes with critical limb ischaemia. METHODS From January 1999 to December 2003, 420 consecutive patients with diabetes admitted to hospital because of critical limb ischaemia underwent peripheral angiography and concomitant technically successful PTA. Transcutaneous oxygen tension (TcPO(2)) was measured before and after PTA. Major amputation at 30 days was recorded. RESULTS After PTA, the iliac-femoral-popliteal axis was patent in all patients. In 67 patients, all three crural arteries were patent, in 143 patients 2 crural arteries were patent, and in 186 patients one crural artery was patent (104 peroneal, 62 anterior tibial, 20 posterior tibial). In 24 patients, all three crural arteries were occluded. Twenty-two major amputations were performed. Of these, 15 were performed in the 24 patients with occlusion of all the infrapopliteal arteries. Seven of the 186 patients in whom only the peroneal artery was patent required amputation. In patients not requiring amputation, TcPO(2) increased from 15.5 +/- 11.9 to 45.0 +/- 12.0 mmHg (P = 0.000), while in those requiring amputation, TcPO(2) increased from 9.6 +/- 7.7 to 18.6 +/- 8.1 mmHg (P < 0.082). Multivariate analysis indicated an independent role of occlusion of infrapopliteal arteries after PTA (OR 8.20 for every crural obstructed artery, P = 0.022, CI 1.35-49.6) and TcPO(2) after PTA (OR 0.80 for increase of 1 mmHg, P < 0.001, CI 0.74-0.88). CONCLUSIONS In patients with diabetes, PTA is effective in avoiding major amputation, provided recanalization occurs in at least one tibial artery down to the foot. In a few patients, re-canalization of the peroneal artery alone is not sufficient to avoid major amputation.
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Affiliation(s)
- E Faglia
- Diabetology Centre-Diabetic Foot Centre- IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
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Clerici G, Koutras I, Luzietti R, Di Renzo GC. Multiple true umbilical knots: a silent risk for intrauterine growth restriction with anomalous hemodynamic pattern. Fetal Diagn Ther 2007; 22:440-3. [PMID: 17652933 DOI: 10.1159/000106351] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 08/29/2006] [Indexed: 11/19/2022]
Abstract
True knots of the umbilical cord can represent a serious complication for the fetus due to the possible alteration in the fetal circulation with consequent intrauterine growth restriction or fetal death. We report a case of 5 true umbilical cord knots associated with severe fetal growth restriction and an abnormal hemodynamic pattern. The Doppler examination showed a hemodynamic pattern characterized by an early alteration in the waveform profile in the fetal venous districts with normal impedance to flow values in both uterine and umbilical arteries. This normal profile of the umbilical arteries remained unchanged until the last stage of hemodynamic decompensation, while the profiles of the uterine arteries remained normal until delivery. This case report suggests that it is important to pay close attention to the evaluation of the fetal cord in situations in which the above described hemodynamic pattern is noted. Although the ultrasound diagnosis of true knots is extremely difficult, the presence of a true knot should always be suspected in the presence of an intrauterine growth restriction fetus when the venous district is altered before the fetal arterial districts after exclusion of other detectable reasons for growth restriction.
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Affiliation(s)
- G Clerici
- Centre of Perinatal Medicine, Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.
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Faglia E, Clerici G, Caminiti M, Quarantiello A, Curci V, Morabito A. Predictive Values of Transcutaneous Oxygen Tension for Above-the-ankle Amputation in Diabetic Patients with Critical Limb Ischemia. Eur J Vasc Endovasc Surg 2007; 33:731-6. [PMID: 17296318 DOI: 10.1016/j.ejvs.2006.12.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 12/20/2006] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the values of transcutaneous oxygen tension (TcPO2) capable of predicting above-the-ankle amputation in diabetic patients diagnosed for critical limb ischemia (CLI) according to the criteria of the TransAtlantic Inter-Society Consensus. DESIGN Retrospective study. METHODS From January 1999 to December 2003, 564 diabetic patients were consecutively hospitalized for CLI in one limb. Revascularization with angioplasty or bypass graft was performed when possible and, if not possible, prostanoid therapy was used. In patients in whom therapies did not relieve the rest pain or the gangrene was extended above the Chopart joint, an above-the-ankle-amputation was performed. After treatment TcPO2 values were evaluated in all patients at the dorsum of the foot. RESULTS Fifty-five (9.8%) patients underwent an above-the-ankle amputation: 22 of 420 patients who underwent angioplasty, 17 of 117 patients who underwent bypass (14.5%) and 16 of 27 patients in whom revascularization was not possible. Post-treatment TcPO2, measured by a receiver operating characteristic (ROC) curve, showed a value 34 mmHg as the best threshold for determining the need for revascularization, with an area under the curve of 0.89 (95%CI 0.85-0.94). Using logistic regression analysis the probability of above-the-ankle amputation for this threshold is 9.7% and reduces to 3% for TcPO2 > 40 mmHg. CONCLUSION TcPO2 levels<34 mmHg indicate the need for revascularization, while for values >or= 34 < 40 mmHg this need appears less pressing, although there remains a considerable probability of amputation. TcPO2 levels greater than 40 mmHg suggest that revascularization is dependent on the severity of tissue loss and possible morbidity caused by the procedure.
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Affiliation(s)
- E Faglia
- Diabetology Center-Diabetic Foot Center, IRCCS Multimedica, Sesto San Giovanni, Milano, Italy.
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Abstract
Preterm birth remains one of the serious problems in perinatal medicine and is associated with an increased risk of neonatal complications and long-term morbidity. Although each day that delivery is delayed between 22 and 28 weeks of gestation increases survival by 3%, since most spontaneous preterm labour occurs between 28 and 34 weeks of gestation, this is of secondary concern; the primary goal of delay is to improve the function of certain systems in the fetus and to balance the risks of a hostile intrauterine environment with the complications of extrauterine preterm life. Although there is a lack of definitive evidence that tocolytic drugs improve outcome following spontaneous preterm labour and preterm birth, there is ample evidence that tocolysis delays delivery for long enough to permit administration of a complete course of antepartum glucocorticoids and to facilitate in utero transfer to a tertiary care unit where neonatal care will be optimal. Both these measures have been associated with improved outcomes; antepartum glucocorticoids reduce the incidence of respiratory distress syndrome, intraventricular haemorrhage, periventricular leucomalacia and necrotising enterocolitis, and in utero transfer is associated with decreased morbidity and mortality and less hospital-based intervention compared with postnatal transportation. Consequently, women who are more likely to benefit from tocolysis are those at early gestational ages, those needing transfer to a hospital that can provide neonatal intensive care and those who have not yet received a full course of antepartum glucocorticosteroids. In these cases, delaying labour for at least 48 hours with drugs such as atosiban should be considered, since it offers clear advantages for the fetus.
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Affiliation(s)
- G C Di Renzo
- Department of Gynaecology and Obstetrics, Centre of Reproductive and Perinatal Medicine, University of Perugia, Policlinico Monteluce, Perugia, Italy.
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Pérard L, Hot A, Desmurs H, Simon M, Clerici G, Maignan M, Coppéré B, Girard Madoux MH, Finet G, Ninet J. Thrombose coronaire survenue sous AVK chez un patient porteur d'un déficit hétérozygote du facteur V Leiden. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, Caminiti M, Curci V, Lupattelli T, Morabito A. Early and Five-year Amputation and Survival Rate of Diabetic Patients with Critical Limb Ischemia: Data of a Cohort Study of 564 Patients. J Vasc Surg 2006. [DOI: 10.1016/j.jvs.2006.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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